Treatment for leukaemia

Tuesday 30 April, 2013

Reviewed: Annie Angle cancer nurse, Diploma Oncology Nursing, Royal Marsden, London

On this page: Chemotherapy | Induction therapy | Consolidation therapy | Maintenance therapy | Side effects of chemotherapy | Stem cell (or bone marrow) transplantation | Side effects of stem cell transplantation | Immunotherapy with interferon | Side effects of interferon treatment | All-trans-retinoic acid | Prognosis | Recovery | Life after treatment


In recent years, a lot of progress has been made in treating acute leukaemia, especially acute lymphocytic leukaemia. The main treatment used is chemotherapy. Some people have high-dose chemotherapy with stem cell transplantation. Treatment for each leukaemia is different, so this information is general. Your doctor will be able to tell you more about your treatment.

People with chronic lymphocytic leukaemia may not need treatment for many years. They may just need regular check-ups and blood tests. People with chronic myeloid leukaemia are usually treated with the drug imatinib (Glivec ). A newer medication, dasatinib, is now available for some patients with chronic myeloid leukaemia. People with one type of acute myeloid leukaemia may be treated with a form of vitamin A called all-trans-retinoic acid and chemotherapy.

If it's possible you could become pregnant, you must use effective contraception while being treated, since the drugs used could harm the foetus.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs. The aim is to destroy all cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing.  

Chemotherapy drugs are usually taken intravenously, that is, they are injected or infused into a vein. To avoid having repeated injections, a long-lasting catheter in a vein is usually used. The drugs can then be added to a fluid drip attached to the catheter.

Some chemotherapy is in tablet form or given as injections under the skin. Chronic lymphocytic leukaemia is usually treated in this way.  

For some people, chemotherapy for acute leukaemia will mean spending several weeks in hospital. Others may be able to stay at home but will need regular hospital visits for check-ups and further treatments.

Three different phases of chemotherapy are used to treat acute leukaemia – induction therapy, consolidation therapy and maintenance therapy.

Induction therapy

Treatment begins with induction therapy, which usually lasts four to six weeks. This is a phase of intense treatment aimed at destroying as many abnormal white blood cells as possible. The aim is to effect a remission.

You're said to be in remission when there are no signs of leukaemia in your blood and bone marrow.

After remission, people with acute lymphocytic leukaemia have extra treatment. As microscopic collections of leukaemic cells may have spread to the spinal fluid, chemotherapy drugs are injected directly into the fluid around your spine. You may also have radiotherapy.

In children, radiotherapy is often not used because it may affect growth and development. 

Consolidation therapy

After remission, more chemotherapy can be used to try to stop the cancer coming back (called a relapse). The goal of this second phase of treatment is to destroy any cancer cells that may have survived the first treatment. A number of different chemotherapy drugs are usually used. This is in case the leukaemia cells are resistant to any one drug.

Maintenance therapy

Maintenance therapy is the final stage of treatment for acute lymphocytic leukaemia in children. It's given over a longer period of time (two to three years), but its aim is the same: to destroy remaining cancer cells.

In most of the acute myeloid leukaemias, the role and duration of maintenance chemotherapy is still being studied. In many people it isn't currently used.

In general, this phase of treatment isn't as intense as the first two phases. It may sometimes be replaced by stem cell (bone marrow) transplantation after high-dose chemotherapy.

Side effects of chemotherapy

The most important effect of chemotherapy is that it kills leukaemia cells. However, it may have side effects. Normal cells are better able to renew themselves after chemotherapy than leukaemia cells, but some normal cells which multiply rapidly (such as hair cells and normal blood cells) may be affected by chemotherapy.

Reactions vary with different drugs, with different people and from one course of treatment to the next. Doses of chemotherapy which are moderate, such as those used for treatment of chronic leukaemia, usually cause few side effects.

The most common side effects are nausea and vomiting, feeling off-colour and tired, hair loss, diarrhoea, constipation and a sore mouth. If normal blood cells are affected, you may also have problems with infection and bleeding. Tell your doctor if you have any of these side effects.  

Imatinib (Glivec) is being increasingly used to treat chronic myeloid leukaemia. It's sometimes added to chemotherapy to treat a type of acute lymphocytic leukaemia. Its side effects include mild feelings of sickness, diarrhoea, leg aches and cramps, rashes, and swelling around the eyes.

All-trans retinoic acid, used to treat a type of acute myeloid leukaemia, may cause headaches, bone pain and dry skin. Remember that side effects can be prevented or controlled. Ask for advice on any possible reactions you may have and the best ways for you to cope with them.  

Stem cell (or bone marrow) transplantation

This treatment allows you to have higher doses of chemotherapy than usual. This may increase your chance of being cured. It can be exhausting and has significant risks. Newer forms of transplantation (called mini allografts or reduced-intensity allografts) use lower doses of chemotherapy. They attempt to use the immune system to fight the leukaemia. 

For some younger patients with acute leukaemia in remission this treatment greatly increases the chance of long-term remission and cure.

Stem cell transplantation is rarely used as the first treatment for children with acute lymphocytic leukaemia because chemotherapy usually works very well.

Stem cells grow in bone marrow (the soft tissue inside bones). They're immature cells, from which essential new cells for the body grow. High doses of chemotherapy can harm stem cells. So if you need high dose chemotherapy, and your doctor thinks you're strong enough, this treatment can put healthy stem cells into your body after the chemotherapy.

Stem cells can be taken from blood (this is called peripheral stem cell transplantation) or directly from bone marrow (this is called bone marrow transplantation).

The stem cells will either come from you before your chemotherapy (autologous donor) or from a donor whose stem cells closely match yours (allogeneic donor).

You or the donor may have injections of a growth factor beforehand. This stimulates the bone marrow to produce large numbers of stem cells for collection.

You (or the donor) will have blood taken by syringe from a vein (usually in your arm) or from a small tube going through a vein in your neck or chest. The blood goes through a machine that spins the cells at very high speed. A computer is used to separate the stem cells, which are placed in a collection bag.  

If your own stem cells are taken, the remaining blood cells will be returned to your body. An anticoagulant will prevent the blood clotting; it may cause a tingling in your fingers or lips. Let the nurse know if this happens and changes can be made.

Sometimes, stem cells are taken from the bone marrow in the hipbone or breastbone. This is done in an operating theatre under general anaesthetic.

The stem cells will be put in your body after your high dose chemotherapy. It's like a blood transfusion.

The cells will find their way into the bone marrow. This will eventually result in normal blood cell numbers. This can take some time. While you're in hospital you'll have a range of treatments aimed to help the treatment work.

Ask your doctor or nurse for information about the transplant you'll be having.

Side effects of stem cell transplantation

While you're waiting for the treatment to work, you'll be prone to infections. You may bruise and bleed more easily, and may become weak, with little energy. Other possible side effects include mouth infection and ulcers, nausea, vomiting, diarrhoea or bleeding from the bladder. Let your nurse and doctor know if you have any of these symptoms so they can be treated.

Some people who receive allogeneic stem cells develop graft-versus-host disease (GVHD), where the donor cells ‘attack' the person's organs and tissues. Generally, when this happens, it causes mild symptoms, but sometimes GVHD can be a serious illness. Discuss the risks with your doctor if you're going to have an allogeneic transplant.

Immunotherapy with interferon

Interferon is a protein that's normally made by the body and has anti-cancer effects. It used to be used to treat chronic myeloid leukaemia but this is less common now.

You'll have interferon by daily injection under the skin. You may learn how to give yourself the injections, or they may be given by someone living with you, or by a visiting nurse.

Side effects of interferon treatment

Interferon can cause flu-like symptoms (fever, chill and sweats) one to two hours after the injection. Some people have the injection before they go to bed, so these symptoms don't interfere too much with day-to-day life. Other side effects include tiredness, loss of appetite and muscle pain. Interferon can also affect blood counts just like chemotherapy and you'll need regular blood tests.

All-trans-retinoic acid

This is a form of vitamin A used to treat a type of acute myeloid leukaemia called acute promyelocytic leukaemia. It's usually taken in tablets with chemotherapy. Some people have headaches, dry skin, dry mouth and bone pain while taking this treatment.

For information about specific treatments and treatment by stage of leukaemia see the Leukaemia Foundation website

Prognosis

The prognosis for people with all forms of leukaemia is improving all the time, with better understanding of the disease and new treatments.

Most children and many adults with acute leukaemia can expect to be cured with modern treatments. Even people who aren't cured usually have prolonged remission and normal lives for the duration of their remission.

For most people, chronic leukaemias can be controlled and normal life enjoyed for long periods of time. Treatment for chronic myeloid leukaemia gives prolonged remission in most people and new treatments are curing many people. Patients with early stage chronic lymphocytic leukaemia may never need treatment.

Many people want to know about the risk of their leukaemia returning or relapsing. Everyone is different, so it's usually not possible to give definite answers. Factors such as the type of leukaemia you have, your symptoms and your age all affect your prognosis, so it's best to discuss your situation with your doctor.

Recovery and follow-up care

Your doctors may want to examine you every 3 months for the first year after your treatment, every 6 months between the second and fifth years of your treatment, and once a year after that. They'll examine you and ask about any symptoms you've had, and will answer any questions you have. Your doctor may order other tests or scans if they think they're needed.

Life after treatment

After treatment for leukaemia you're likely to face several changes in your life. For some people these changes may be short term. Other changes may be permanent and difficult to cope with. Most people find they need information and support about how to best deal with their situation.
For more information see the links below or contact Cancer Council on 13 11 20 to speak with a cancer nurse.

Updated: 30 Apr, 2013